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All trauma patients, no matter how far along in their pregnancy, get an ED evaluation first. Biggest cause of fetal mortality after trauma is maternal mortality. OB may miss subtle signs of injury that could lead to problems.
Once a complete ED evaluation is done, then they go to OB for at least 6 hours of TOCO/FHR monitoring.
See the following articles for good info/guidelines:
"Pregnancy outcome and fetomaternal hemorrhage after non-catastrophic trauma" American Journal of Obstetrics and Gynecology 1990;162:665-671
"Evaluation and treatment of the gravida and fetus following trauma during pregnancy" Obstetric and Gynecologic Clinics of North America 1991;18:371-381
Summary of articles is below:
Perform trauma assessment and treatment as usual with the following additions:
Assess FHR early
Tocodynamic monitoring ASAP and for 6 hours after trauma
Need continuous monitoring to better evaluate for decelerations and beat to beat variability
Patients admitted for other reasons should be monitored throughout their hospitalization
Patients with significant risk factors
MHR > 110
ISS > 9
Absent FHT
FHR 160
Ejection
MCC
Pedestrian collision
ALL get monitored for at least 24 hours
Others
Monitor for 6 hours
If no evidence of frequent contractions or FHR changes may be discharged
3rd trimester status without other risk factors is not an indication for prolonged (24 hour) monitoring
The reason I was asking the initial question is that we are in the process of revamping our standards of practice for pregnant females in the ED.
For really basic, low impact MVC >20 weeks who has not sustained major trauma, we are now planning on having OB/GYN set up at least continuous FHR monitoring while being evaluated in ED (obviously same for pregnant major traumas). (Even though as stated earlier that major indication for fetal death is major maternal injury). Previously for low impact MVC's, we would do spot check FHR.
For those of you who evaluate >20 weeks pregnant females in ED first before sending to L+D, do you do continuous FHR monitoring and/or tochometer (am I spelling that right? ie., contraction monitor).
Just curious what other places are doing for their Standards of Practice. Thanks! :) Jeanne
jeannet83
64 Posts
Hi, everyone! I have a clinical question and wanted peoples' opinions since every facility is different. When you have a greater than 20 week pregnant female who was involved in a minor or major MVC, what is your facility's standard of practice for patient care?
For instance, at our facility, we clear the patient medically before sending them to L+D. What does your facility do?
Thanks for your input! Jeanne :)